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Globalization and Health
Published in: Globalization and Health 1/2017

Open Access 01-12-2017 | Research

Donor-funded project's sustainability assessment: a qualitative case study of a results-based financing pilot in Koulikoro region, Mali

Authors: Mathieu Seppey, Valéry Ridde, Laurence Touré, Abdourahmane Coulibaly

Published in: Globalization and Health | Issue 1/2017

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Abstract

Background

Results-based financing (RBF) is emerging as a new alternative to finance health systems in many African countries. In Mali, a pilot project was conducted to improve demand and supply of health services through financing performance in targeted services. No study has explored the sustainability process of such a project in Africa. This study’s objectives were to understand the project’s sustainability process and to assess its level of sustainability.

Methods

Sustainability was examined through its different determinants, phases, levels and contexts. These were explored using qualitative interviews to discern, via critical events, stakeholders’ ideas regarding the project’s sustainability. Data collection sites were chosen with the participation of different stakeholders, based on a variety of criteria (rural/urban settings, level of participation, RBF participants still present, etc.). Forty-nine stakeholders were then interviewed in six community health centres and two referral health centres (from 11/12/15 to 08/03/16), including health practitioners, administrators, and those involved in implementing and conceptualizing the program (government and NGOs). A theme analysis was done with the software © QDA Miner according to the study’s conceptual framework.

Results

The results of this project show a weak level of sustainability due to many factors. While some gains could be sustained (ex.: investments in long-term resources, high compatibility of values and codes, adapted design to the implementations contexts, etc.) other intended benefits could not (ex.: end of investments, lack of shared cultural artefacts around RBF, loss of different tasks and procedures, need of more ownership of the project by the local stakeholders). A lack of sustainability planning was observed, and few critical events were associated to phases of sustainability.

Conclusions

While this RBF project aimed at increasing health agents’ motivation through different mechanisms (supervision, investments, incentives, etc.), these results raise questions on what types of motivation could be more stable and what could be the place of local stakeholders in the project; all this with the aim of more sustained and efficient results.
Footnotes
1
Italic quotes have been freely translated from French (or Bambara) by the main researcher (or the local translator) who did the data collection.
 
2
Bambara vocabulary
 
3
Idem
 
4
Idem
 
5
Rumours have been confirmed with the WB implementing another pilot project for the whole region of Koulikoro. This pilot took place for only 3 months (October to December 2016) due to different delays. There is no sign in this last report if a RBF scale-up will be implemented.
 
6
The Agence National d’Évaluation des Hôpitaux did not serve during RBF, it was instead independent NGOs that had the role of being external auditors.
 
7
At the moment of the writing of this article, no information demonstrates that the WB will start another RBF project in Mali.
 
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Metadata
Title
Donor-funded project's sustainability assessment: a qualitative case study of a results-based financing pilot in Koulikoro region, Mali
Authors
Mathieu Seppey
Valéry Ridde
Laurence Touré
Abdourahmane Coulibaly
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2017
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-017-0307-8

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